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Glucocorticoids are potent antiinflammatory medications that are widely used in the treatment of chronic inflammatory disease such as asthma, chronic lung disease, rheumatoid arthritis and other connective tissue diseases, inflammatory bowel disease. Examples of glucocorticoids include:

• Prednisone
• Prednisilone
• Methylprednisilone
• Dexamethasone
• Hydrocortisone

While the benefits of glucocorticoids are great, the side effects can be significant. Osteoporosis and related fractures are some of the most serious adverse effects.

Skeletal wasting is most rapid during the first 6 months of glucocorticoid therapy. The effects are both dose and duration dependent. Osteoporosis due to glucocorticoids occurs as a result of several mechanisms, including:

• Effects on calcium homeostasis
• Effects on sex hormones
• Inhibition of bone formation

Glucocorticoid-induced bone loss can be both prevented and treated. Ongoing monitoring should be combined with the following strategies as appropriate:

• Use of the lowest effective dose of glucocorticoid possible
• Smoking cessation
• Limitation of alcohol consumption
• Participation in a weight-bearing exercise program for 30-60 minutes a day
• Calcium supplementation
• Vitamin D supplementation
• Thiazide diuretics (to help decrease urinary excretion of calcium)
• Bisphosphonates
• Estrogen treatment (women); androgens (men)
• Calcitonin